More study on HS football concussions, experts say

NEW YORK - October 30, 2009

Jarek, 16, returned to high school in Norwich, Conn., on Monday after a neurologist sent him home for most of last week. He suffered a concussion during football practice, and while the nausea and blurred vision he endured in class the next day had gone away, the headaches continued.

Still banned from football on doctor's orders, he's "not doing too bad," said his mother, Donna Dombrowski. But the headaches have been coming back in the afternoons.

Dombrowski said the recent news reports about retired NFL players blaming mental problems on gridiron head injuries have made her think about Jarek. She isn't sure how concerned to be. And while she enjoys seeing him play, she's torn about whether she wants him to suit up again.

In fact, experts say they know very little about long-term medical risks of concussion for America's football players still in high school.

A congressional hearing in Washington on Wednesday focused on the NFL. A month ago, a preliminary study suggested that retired football players may have a higher than normal rate of Alzheimer's disease or other memory problems, presumably because of head injuries. But at the hearing, Rep. John Conyers, D-Mich., said he'd seek records on head injuries in amateur ranks as well, "because of the effect on the millions of players at the college, high school and youth levels."

Every year, as many as 1 in 10 high school football players has a concussion, estimated Kevin Guskiewicz of the University of North Carolina at Chapel Hill. He is lead author of the National Athletic Trainers' Association position statement on concussion management.

He said nobody has followed such players systematically for a decade or more to see what effect concussions might have.

He sees reason for concern. In 2005, he published a study of retired pro players that found having three or more concussions was associated with a heightened risk of mild cognitive impairment after age 50.

"One would assume a high school player who likewise had three or more during his high school years would potentially be predisposed to some of these same long-term neurodegenerative conditions that NFL players are," he said. But, he stressed, there's no evidence for that.

Mark Lovell, who directs the sports medicine concussion program at the University of Pittsburgh Medical Center, said he has begun to collect data on long-term consequences of high school concussions. He noted that the kind of careful mental testing his center does has not been widely used until fairly recently, so there is no big database yet of people who've been followed a long time since high school.

As it stands now, "we can't look into the future" and tell who is going to develop a long-term problem from one or more concussions, he said.

"I can tell you that I don't think anyone knows exactly what the long-term risk is, and I wish I did.... For a given kid, if we knew that kid was going to be at risk for long-term problems, we could get him or her in a different sport early on," Lovell said.

So what can be done now to reduce the risk of long-term trouble?

Experts say players, coaches and parents must learn to recognize the symptoms of a concussion, and be ready to pull affected players out of competition until a health professional clears them to play again. Players should not return to action until their brains heal, because it's dangerous to get a second concussion when the brain is still recovering from the first one.

"When in doubt, sit them out," Lovell said.

Determining when it's safe to play again is more complicated than just waiting until symptoms disappear, said Dr. Anthony Alessi, who co-chairs the American Academy of Neurology's sports neurology section. He's working to update the academy's 1997 guidelines on how long to keep an athlete out after a concussion.

Alessi, who is chief of neurology at the William W. Backus Hospital in Norwich, Conn., also recommends that every high school should have a certified athletic trainer on the sidelines. Only 42 percent of high schools use the services of one, according to the trainers' association.

And he suggests that coaches limit the number of practices in which players slam into each other at full speed. Teams that have only one full-contact practice a week perform as well as those with four, with much less risk of concussion, Alessi said.

"We can reduce the risk and still keep the level of play up there," he said.

Earlier this month, Alessi told a 16-year-old that his football season at a Norwich high school was over. The boy, M.J. Belmont, had just had his third concussion in two years, this one at a practice.

M.J.'s mother Christine said she hasn't asked Alessi about whether M.J. can play football next season.

"I'm hesitant to have him on the field again," she said. "The mother in me says, `No way,' but I also know how much he loves it, and how do you say no? It's part of who he is ... Part of what makes M.J. a whole person is loving football and being part of the team."

She also has a 13-year-old son who loves playing football, and will start high school next year. And that, she said, is "kind of scary."

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